The changing profile of the cardiac donor

Background: Expansion of traditional donor criteria has become standard in most centers. To determine how this has affected donor profiles, at our ins titution, we reviewed all adult (age greater than or equal to 16) cardiac d onors of the past 15 years. Methods: We separated 261 cardiac donors into 2 groups based on time period s: Group I, 1983 to 1991 (n = 131), and Group II, 1991 to 1998 (n = 130). Results: The groups differed significantly in mean donor age (26.2 years vs 30.9; p < 0.001), percent older than 40 years (6% vs 27%; p < 0.001), perc ent female (23% vs 35%; p = 0.04), percent distant procurement (54% vs 22%; p < 0.001), and percent minority donors (14% vs 29%; p < 0.001). We found an increase in non-traumatic deaths (24% vs 40%; p = 0.008). Older donors h ad significantly more non-traumatic deaths than younger donors (79% vs 13%; p < 0.001). Overall 5-year survival of recipients was 64% and was not sign ificantly different between our early and late experiences (60% vs 68%; p = not significant [NS]). Recipients with hearts from older donors had a 5-ye ar survival similar to recipients with younger donor hearts (61% vs 64%; p = NS). Traumatic and non-traumatic donors had similar 5-year survivals (64% vs 63%, p = NS). A stepwise multivariate analysis of the entire cohort ide ntified donor age, donor weight, recipient United Network for Organ Sharing status, and cardiopulmonary bypass time as significant independent risk fa ctors for recipient survival. Recipients of hearts from donors < 90 kg had significantly better 5-year survivals than recipients from donors : 90 kg ( 66% vs 48%; p = 0.01). Conclusions: Our evolving cardiac donor pool now has more minorities, women , and older donors whose deaths are often non-traumatic. At our institution , donor pool expansion has had no adverse effect on the long-term survival of recipients.